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Non-specific Abdominal Pain

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Emergency laparoscopic surgery in the elderly and frail patient

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Abstract

The number of elderly and frail patients admitted to the Emergency Department (ED) reporting non-specific abdominal pain (NSAP) is going to increase in the next decades.

Acute abdomen remains a clinical challenge in the elderly patient. To distinguish which patients need surgery from non-surgical abdominal illnesses can be difficult. Less severe conditions can mimic major diagnoses requiring early intervention. Early diagnosis is essential in such patients, as delayed treatment can worsen overall clinical outcomes, especially in case of perforated peptic ulcer, acute cholecystitis and perforated diverticulitis. The use of computed tomography (CT) scan should be liberal, as the long-term side effect of radiation is of less concern in the elderly, compared to younger patients. Efforts to explain to the patient the range of therapeutic alternatives, risks and possible outcomes should precede final treatment decisions.

Non-specific abdominal pain (NSAP) patients may be approached with different strategies, including clinical observation, laboratory tests, imaging (ultrasound (US) and/or CT scan), surgery (open or laparoscopic) or sent home early with planned outpatient follow-up. Even though relevant literature across the years has been published, it is not well established as to which approach guarantees the best outcome. Early laparoscopy maintains both a diagnostic and a therapeutic role, reduces hospital stay, improves morbidity and mortality, quality of life and it is cost-effective. Risk and benefits of this strategy have to be addressed individually.

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Author information

Authors and Affiliations

  1. General and Emergency Surgery Unit, Umberto Parini Hospital, Aosta, Italy

    Riccardo Brachet-Contul, Mario Junior Nardi, Salvatore Condurro & Paolo Millo

  2. Department of Surgical Sciences, University of Turin, Turin, Italy

    Lorenzo Cinti

  3. Department of Surgical and Medical Sciences, Surgical and Oncological Unit, Policlinico Le Scotte, Siena, Italy

    Daniele Marrelli

Authors
  1. Riccardo Brachet-Contul
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  2. Lorenzo Cinti
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  3. Mario Junior Nardi
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  4. Salvatore Condurro
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  5. Paolo Millo
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  6. Daniele Marrelli
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Corresponding author

Correspondence to Riccardo Brachet-Contul .

Editor information

Editors and Affiliations

  1. Department of General Surgery, ULSS2 Trevigiana del veneto, Vittorio Veneto (TV), Italy

    Ferdinando Agresta

  2. Policlinico Universitario Duilio Casula, AOU Cagliari, Department of Emergency Surgery, Monserrato, Italy

    Mauro Podda

  3. General Surgery, Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, Viterbo, Italy

    Fabio Cesare Campanile

  4. Department of Emergency Surgery, AOU Careggi, Firenze, Italy

    Carlo Bergamini

  5. UO di chirurgia Generale e Toracica, AOU Ferrara, Ferrara, Italy

    Gabriele Anania

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Brachet-Contul, R., Cinti, L., Nardi, M.J., Condurro, S., Millo, P., Marrelli, D. (2021). Non-specific Abdominal Pain. In: Agresta, F., Podda, M., Campanile, F.C., Bergamini, C., Anania, G. (eds) Emergency laparoscopic surgery in the elderly and frail patient. Springer, Cham. https://doi.org/10.1007/978-3-030-79990-8_12

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  • DOI: https://doi.org/10.1007/978-3-030-79990-8_12

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